This inspection took place on the 19 and 20 September 2017. We gave the service 24 hours’ notice of the inspection to ensure that the managers were available to speak with us. This was the first inspection of Imagine Act and Succeed since it had been re-registered with the Care Quality Commission in June 2016. The re-registration had taken place due to a change in the office address for the service. The service, under its previous registration as IAS 65 Chorley Road, was inspected in May 2015 and was rated good overall.

Imagine Act and Succeed (IAS) is registered to provide personal care in people’s own homes. The service supports 55 people through their domiciliary care service, 22 people in an extra care scheme (Fiona Gardens) and 21 people lived in supported living properties, either on their own or sharing with others. The domiciliary care service provided support from one visit per week to multiple visits each day. The extra care scheme provided assessed support for 22 people and an emergency on call service for the remaining 50 flats in the scheme. Some of the supported living houses provided 24 hour support and others a planned schedule of support, depending on the assessed need.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All the people who used the service and their relatives were complimentary about IAS and the support provided. The staff said they enjoyed working for the service and felt very well supported by their service leaders and senior managers.

There were sufficient staff on the rotas to meet people’s needs. In the domiciliary care service people said they were supported by regular staff, who were on time and did not miss visits. Relatives said the supported living staff teams were kept as stable and consistent as possible. This meant people were supported by staff who knew them and their support needs well. We were told there was good communication between the staff and people’s relatives.

Detailed person centred care plans and risk assessments were in place. These provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate the identified risks. Comprehensive positive behaviour support plans were in place for those people with complex behaviours which may challenge the service.

Each person had a one page profile in place documenting key likes, dislikes and how they wanted to be supported.

A living well document was being introduced, part of which documented people’s wishes for their end of life care and support. Some people had completed this; however others did not want to discuss the end of their lives. People living at Fiona Gardens were supported to stay in their flat at the end of their lives if possible. Additional visits were made as their needs changed.

People and their families were involved in writing and reviewing the care plans and risk assessments. Relatives said they had regular feedback from the staff teams about their loved ones.

People received their medicines as prescribed. A medicines lead role and a new medicines system (called Bio-dose) had been introduced at Fiona Gardens in response to a series of medication errors. This had resulted in a large reduction in the medication errors made. We have made a recommendation that all medicines leads are made aware of the full prescribing instructions for the medicines they administer.

Guidelines for when ‘as required’ medicines were to be administered were in place in the supported living service. At the time of our inspection all the people supported at Fiona Gardens were able to tell staff if they needed an ‘as required’ medicine. We discuss